Survival after abdominal aortic aneurysm repair is affected by socioeconomic status

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Journal of Vascular Surgery


OBJECTIVE: The association between socioeconomic status (SES) and outcome after abdominal aortic aneurysm (AAA) repair is largely unknown. This study aimed to determine the influence of SES on postoperative survival after AAA repair.

METHODS: Patients undergoing surgical treatment of AAA at a tertiary referral center between January 1993 and July 2013 were retrospectively collected. Thirty-day postoperative mortality and long-term mortality were documented through medical record review and the Michigan Social Security Death Index. SES was quantified using the neighborhood deprivation index (NDI), which is a standardized and reproducible index used in research that summarizes eight domains of socioeconomic deprivation and is based on census tracts derived from patients' individual addresses. The association between SES and survival was studied by univariable and multivariable Cox regression analysis.

RESULTS: A total of 767 patients were included. The mean age was 73 years; 80% were male, 77% were white, and 20% were African American. There was no difference in SES of patients who underwent open vs endovascular repair of AAA (P = .489). The average NDI was -0.18 (minimum, -1.47; maximum, 2.35). After adjusting for the variables that were significant on univariable analysis (age, medical comorbidities, length of stay, and year of surgery), the association between NDI and long-term mortality was significant (P = .021; hazard ratio, 1.21 [1.05-1.37]).

CONCLUSIONS: Long-term mortality after AAA repair is associated with SES. Further studies are required to assess which risk factors (behavioral, psychosocial) are responsible for this decreased long-term survival in low SES patients after AAA repair.

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